Provider Demographics
NPI:1740879352
Name:STOKES, KENNISHA
Entity type:Individual
Prefix:
First Name:KENNISHA
Middle Name:
Last Name:STOKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 BAYHEAD DR APT 1414
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-8702
Mailing Address - Country:US
Mailing Address - Phone:757-239-8567
Mailing Address - Fax:
Practice Address - Street 1:1462 BAYHEAD DR APT 1414
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-8702
Practice Address - Country:US
Practice Address - Phone:757-239-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA251E00000XMedicaid